The European Health and Behaviour Survey: rationale, methods and initial results from the United Kingdom

The aim of this study was to assess a wide range of health-related behaviours, beliefs concerning the importance of behaviours for health, and health knowledge, using a standardized protocol suitable for translation and administration in different countries of Europe. An inventory was developed from previous literature for the assessment of substance use, positive health practices, diet and eating habits, driving behaviour and preventive health care, beliefs concerning the importance of 25 activities for health, and knowledge about the influence of seven factors (including smoking, alcohol and diet) on major diseases. The first phase of the study involved administration of the inventory to approximately 200 male and 200 female university students aged 18-30 in 20 European countries. This report concerns data collected from 419 students in the U.K., together with analyses of short-term response stability. The inventory showed adequate short-term stability. Sex differences were observed in a number of behaviours, including consumption of fats and cholesterol, salt and fibre, dieting, exercise, sun-protection, driving speed, regular dental check-ups, frequency of brushing teeth, access to doctor and blood pressure measurement. Beliefs about the importance of behaviours for health were closely associated with the occurrence or frequency of the behaviours both within and between health behaviour categories. Little relationship was observed between health behaviour and awareness of the role of these same factors in disease. Important gaps in health knowledge were identified. Data concerning the frequency of health-related behaviours is crucial to the planning of health education and primary prevention programmes. The close association between beliefs and behaviour emphasises the importance of cognitive factors, while health knowledge appears to play a less direct role.

Control of eating and attributional style

The contribution of attributional style to the prediction of adherence to a dietary regime was assessed. An internal attributional style for negative events was found to predict diet-breaking behaviour. Attributions of 'global' causes for a particular lapse were found to predict a more serious relapse during the period of dietary restriction.

Cognitive restraint and sensitivity to cues for hunger and satiety

The present study provides experimental evidence for the effects of cognitive restraint on sensitivity to internal and external cues of hunger. The design involved four experimental conditions. In each condition the subjects were given either a high calorie or a low calorie early morning drink, and either correctly or incorrectly told its calorie content. The subjects, 10 restrained and 10 nonrestrained normal weight women, then rated their subjective hunger and satiety responses and had a test meal. All subjects reported lower sensations of hunger and higher sensations of fullness after the high calorie drink than the low calorie drink, indicating sensitivity to internal cues. However, the restrained eaters' ratings of hunger were also influenced by the believed content of the drink, indicating sensitivity to external cues. The implications of the results are analysed in terms of current theories of restrained eating and their relevance to further research into pathological eating regulation is discussed.

Behaviour therapy and benzodiazepines: allies or antagonists?

Behaviour therapy and benzodiazepines are directed towards common problems and are often used in combination. At present we know little about the beneficial or adverse interactions of these two treatments. This paper reviews the available literature and suggests that there are important theoretical and clinical issues to be resolved.

Conditioning processes and cue exposure in the modification of excessive eating

Excessive eating is one of the principal characteristics of bulimia. Eating more than intended is also a prominent feature both of obese people who are trying to lose weight and normal weight women who are attempting to restrict their food intake. Overeating tends to be triggered by a specific set of cues, which commonly involve either mood disturbances or exposure to "forbidden" food, but may include other environmental cues. It is argued that conditioning processes are relevant both to the establishment of meal patterns in normal subjects and in the maintenance of excessive eating. Treatment procedures have typically followed the general approach of "Self Management" which emphasises reducing exposure to the cues associated with eating. An alternative approach derives from the idea that the association between eating responses (or urges to eat) and external cues may be learned, and therefore should in principle be ameanable to extinction through systematic unreinforced exposure. In this article the possible mechanisms of cue-induced overeating are discussed and the potential utility of cue exposure techniques for the management of excessive eating evaluated.

Adolescent concerns about weight and eating; a social-development perspective

Eight hundred and forty-six children from multi-cultural schools in neighbourhoods of differing socio-economic background were interviewed concerning their attitudes to weight and eating. The results suggested that weight concern was high in the girls, with more than 50% feeling too fat and wanting to lose weight. The levels of weight concern were almost as high in the 11 year olds as in the 18 year olds, which suggests that weight concerns are beginning earlier than in the past. White girls reported more concern than black or Asian girls. Girls from higher SES background schools showed more concern than those from lower SES schools, although they were actually slimmer. Dieting was also more common in the girls and especially so in white girls and in those from the higher SES schools. However, it was not as common as has been found in North American samples. Within the field of psychological problems these results are unusual in finding evidence for less difficulty in the children from the least socially and culturally privileged backgrounds.

Benzodiazepine research: current findings and practical consequences

The recent research literature on the effects of benzodiazepines is reviewed, with special emphasis on findings relevant for the practising clinician. The mode of action, patterns of use and abuse potential of benzodiazepines are discussed. The evidence on the risks of dependency and possible drawbacks of long-term use are examined. The possible effects of benzodiazepine use on psychological treatments are also examined, and factors that should be considered while treating benzodiazepine users are discussed.

Emotional fainting and the psychophysiologic response to blood and injury: autonomic mechanisms and coping strategies

This experiment was designed to examine the psychophysiologic response pattern associated with emotional fainting. A survey was carried out among students, from which 30 volunteers who reported that they felt faint at the sight of blood or injury were recruited, together with 26 nonfainters. Blood pressure, heart rate, and respiration rate were monitored while subjects viewed a film depicting open-heart surgery and a neutral control film. Parasympathetic cardiac control was indexed by respiratory sinus arrhythmia (RSA), and coping was assessed by questionnaire. Responders (n = 17, group FPOS) were defined by a positive survey rating plus marked lightheadedness during the surgery film, and they were compared with nonresponders (group FNEG). Group FPOS showed a classic diphasic response with increases in heart rate and systolic blood pressure early in the surgery film followed by decreases in both variables, and the pattern was significantly different from that found in group FNEG. Data from three subjects who fainted corroborate these observations, although there were marked individual differences in response. The two groups did not differ in RSA, although RSA was smaller in both groups early in the surgery film than at other points. The positive fainting response group reported focusing their attention on bodily sensations, while those who showed little distress used intellectual coping strategies. The results are discussed in terms of the psychophysiologic mechanisms involved in fainting.

Mean platelet volume and size distribution and their sensitivity to agonists in patients with coronary artery disease and congestive heart failure

Mean platelet volume was related to platelet count in patients with myocardial infarction (n = 55) and patients with congestive heart failure (n = 9). 18 patients with acute myocardial infarction were tested at admission and 4-7 days later, together with 13 patients with chronic stable angina and 10 patients with chest pain which was not related to coronary artery disease. In citrated blood a relative reduced frequency of large platelets (greater than 13 fl) occurred in patients with acute myocardial infarction at admission but was not seen during recovery or in patients with chronic stable angina. This suggests consumption of large platelets at time of thrombus formation. No relation was found between plasma catecholamine levels and mean platelet volumes. Effects of serotonine, adrenaline and CGP 28392, a calcium agonist, on platelet volume distributions were determined. Sensitivity of platelets to adrenaline was increased in patients with acute myocardial infarction on admission and reduced 4-7 days later, while in patients with congestive heart failure reactivity to both serotonine and adrenaline were reduced. This indicates a fast down-regulation during the early recovery phase of myocardial infarction and chronically in congestive heart failure.

Cognitive control of eating

Eating behaviour, unlike many other biological functions, is often subject to sophisticated cognitive regulation. One of the most widely practised forms of cognitive control over food intake is dieting, i.e. attempting to restrict intake as a means of weight regulation. In this paper the development of dieting will be discussed, followed by an evaluation of the impact of cognitive control on food intake regulation. Cross-sectional studies, comparing dieters with non-dieters, suggest that dieting is linked with a variety of disturbances of food intake control, and that it may even provoke paradoxical overeating. An experimental investigation of the link between cognitive control and paradoxical overeating will also be discussed, along with the implications of this work for the understanding and treatment of eating disorders.

The feeling of hunger

Hunger symptoms were assessed in two groups of normal subjects at a variety of times of day. The data showed that relatively few symptoms were endorsed even after longer deprivation periods, and they confirmed other experimental results suggesting that there is no strong and characteristic pattern of hunger symptoms. It is suggested that any notions of disturbed hunger sensations in patients with eating disorders must be evaluated carefully.

Compulsive eating and dietary restraint

The phenomenology of compulsive eating has encouraged comparisons with addictive behaviours and this has suggested that similar underlying processes might be at work. In this paper it is argued that craving for food, preoccupation with eating and loss of control over food intake represent a natural psychobiological adaptation to sub-optimal weight and food deprivation. Compulsive eating is therefore best understood in terms of a conflict between a biologically derived drive for food and a culturally derived drive for thinness. Both of these processes have their parallels in the maintenance of dependency disorders. The crucial difference however is that the urge to eat is biologically adaptive, and recovery from compulsive eating depends upon relaxing restraint.

Eating style: a validation study of the Dutch Eating Behaviour Questionnaire in normal subjects and women with eating disorders

This study is a validation of the Dutch Eating Behaviour Questionnaire (DEBQ). Results from normal men and women confirmed the presence of three robust factors of restraint, emotional eating and external eating. Data from women attending 'weightwatchers', and patients with diagnoses of anorexia nervosa and bulimia indicated that the DEBQ was largely successful in identifying the eating styles which are thought to characterise these three client groups. The results were also evaluated in the light of predictions from restraint theory which suggest that chronic restraint is causally related to higher levels of externality and emotional eating.

Hunger and satiety: a multidimensional assessment of responses to caloric loads

The assessment of hunger in human subjects is complicated by the variety of response systems involved. In the present study, hunger was tracked by subjective, physiological and behavioural responses after identical-tasting high or low calorie preloads. The contribution of nutritional and psychological factors was evaluated by giving half the subjects false information about the caloric content of the preload. Ten women took part, with all subjects participating in each experimental condition and a control condition, in counter-balanced order. The results showed that ratings of hunger symptoms, preferred foods, global hunger and satiety in the inter-meal interval were sensitive both to deprivation effects and to differences in the energy content of the preload. No effects of the psychological manipulation (beliefs about caloric content) were observed. At the test meal two hours later, all the subjective responses converged on a single point and physiological and behavioural responses likewise failed to discriminate the different preload conditions. The results are discussed in terms of a loosely-coupled multidimensional model of hunger.

The relationship between chronic lymphocytic leukaemia and prolymphocytic leukaemia. III. Evaluation of cell size by morphology and volume measurements

The peripheral blood WBC size distribution was assessed by morphological and volume measurements in 73 patients with B-cell chronic lymphocytic leukaemia (CLL) and prolymphocytic leukaemia (PLL). Patients with typical CLL, with less than or equal to 10% prolymphocytes, had a homogeneous major population of small cells which could be recognized both by morphology and volume (median volume 211.5 +/- 32.5 fl). In PLL, the volume of the main cell component was significantly larger than in CLL: in two-thirds of cases the major cell population was distributed in a first lognormal fitted curve of the volume histogram, with median volume 281.8 +/- 38.0 fl; in the remaining cases the main cell component showed a larger median volume (353.5 +/- 71.9 fl) contained within the second lognormal curve which was preceded by a minor peak. CLL patients with 11-55% prolymphocytes (CLL/PL) had characteristic cell volume histograms in which two lognormal curves could always be fitted: in 80% of cases the main cell component was located in a first curve with median volume of 257.9 +/- 28.6 fl; in the remaining cases the major population was represented by cells with median volume of 349.0 +/- 83.9 fl distributed in a second peak. Although in both CLL and CLL/PL the majority of cells was defined morphologically as small, the median volume of these lymphocytes was significantly larger in CLL/PL. The degree of concordance in the assessment of cell size between morphology and volume measurements was high in CLL, whereas in CLL/PL and PLL morphology underestimated the cell size of the major population, compared with its actual volume, in over 50% of cases. We conclude that the identification of prolymphocytes as larger cells in blood films may be hampered by distortions and artefacts of spreading. Volume measurements may provide a more objective indicator of the cell populations in this group of disorders.

Restraint, body image and food attitudes in children from 12 to 18 years

Body image, dietary restraint, attitudes to food and food intake pattern were assessed in a survey of 348 London schoolchildren from three age groups. The data revealed striking sex differences in body image, restraint and food attitudes, even in the youngest age group (12 to 13 years). The majority of girls felt too fat, attempted to restrict their food intake, and expressed guilt about eating. The boys expressed much less concern in all these areas. No differences were found across the age groups. The results suggested that normal English girls experience significant levels of distress over eating and weight.

Response of various blood counting systems to CPD-A1 preserved whole blood

The extent of stability of MCV in whole blood samples used in UK NEQAS surveys has been demonstrated. There are differences in response by various blood counting systems and the relevance of these findings to performance assessment is discussed.